Assessing progress towards the elimination of mother-to-child transmission of syphilis in Peru: A national retrospective analysis

To eliminate and control the mother-to-child transmission (MTCT) of syphilis, the World Health Organization (WHO) recommends meeting the following goals: (1) reducing congenital syphilis incidence to ≤ 0.5 cases per 1000 live births, (2) 90% reduction in maternal syphilis incidence between 2018 and 2030, and (3) 95% coverage of syphilis screening during pregnancy. We evaluated the progress in the Peruvian context at the national and departmental levels. A retrospective ecological analysis was conducted using national secondary data on reported cases of congenital and maternal syphilis from 2015 to 2022. For maternal syphilis, the 2022 goal (2) was defined as a 30% reduction from 2018, approximating the 2030 goal. Percentages of syphilis screening and sociodemographic characteristics were obtained from national Peruvian surveys. Temporal trends were examined using segmented regression, while geographic disparities and spatial clustering were assessed using Marascuilo pairwise comparisons and bivariate Local Moran’s I analyses. In 2022, nationwide syphilis screening during pregnancy was 82.6% (95% CI: 80.7%-84.5%), the congenital syphilis rate was 0.82 cases per 1000 live births, and maternal syphilis increased by 53.7% from 2018. At the department level, only one department achieved all goals; 11, either goal (1) or (2); one, both goals (1) and (2); and 12, neither goal. Segmented regression indicated an acceleration in maternal syphilis rates after 2019. Congenital syphilis rates were highest in departments with the greatest proportions of women with lower education and lack of ANC. Spatial analyses identified high–high clusters of congenital and maternal syphilis in northern departments. This study found that none of the WHO’s Syphilis MTCT goals were met in Peru in 2022. Strengthening decentralized prevention strategies, including scaling up syphilis screening, improving access to ANC, and promoting community engagement within national policies, is essential to reversing current trends and eliminating congenital and maternal syphilis by 2030.